Pedicle frozen autograft reconstruction in malignant bone tumors
Pedicle frozen autograft reconstruction in malignant bone tumors
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DOI：
10.1007/s00776-010-1458-0
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发表时间：
2010-05-01
影响因子：
1.7
通讯作者：
Tomita, Katsuro
中科院分区：
文献类型：
--
作者：
Tsuchiya, Hiroyuki;Nishida, Hideji;Tomita, Katsuro
恶性骨肿瘤保肢手术的规范化应能改善肿瘤切除和重建后的肢体功能。最近，我们开发了一种使用液氮处理的带瘤自体移植物进行生物重建的方法并在临床上应用。我们报告了一种新的改良技术，采用带蒂冷冻自体骨移植，以保留解剖结构的连续性，我们治疗了33例恶性骨肿瘤患者。骨肉瘤17例，转移瘤11例，尤文肉瘤2例，软骨肉瘤2例，未分化多形性肉瘤1例。肿瘤发生于股骨23例，胫骨5例，肱骨4例，跟骨1例。手术方法包括显露肿瘤，行一期截骨或关节脱位，将肿瘤病灶旋转并液氮冷冻20 min，采用髓内钉、钢板或复合材料关节成形术重建，术后功能优25例（75.7%），良5例（15.1%），可3例（9.0%）。在最终随访时，8例患者在术后平均17个月死亡，18例患者在平均30个月（范围7-69个月）的随访期内保持无疾病。7例患者存活，但存在疾病。并发症12例，其中深部感染4例，骨折3例，周围软组织局部复发3例，骨不连2例，塌陷1例。带蒂冷冻自体骨移植是为解决以往报道的游离冷冻自体骨移植的缺点而研制的一种新的移植物，用于恶性骨肿瘤的重建取得了成功。这是一种新的、简单的、有效的生物重建手术技术，仍在研究中，但具有发展潜力。
Standardizing limb salvage surgery for malignant bone tumors should result in improved limb function after tumor excision and reconstruction. Recently, we developed and clinically applied a method of biological reconstruction using tumor-bearing autografts treated with liquid nitrogen. We report this newly modified technique using pedicle frozen autografts to save the continuity of anatomical structures.We treated 33 malignant bone tumor patients. Diagnoses of the tumors were 17 osteosarcomas, 11 metastatic tumors, 2 Ewing's sarcomas, 2 chondrosarcomas, and 1 undifferentiated pleomorphic sarcoma. The sites of the tumors were 23 femurs, 5 tibias, 4 humeri, and 1 calcaneus. Operative procedures consisted of exposing the tumor, performing one-site osteotomy or joint dislocation, rotating and freezing the tumor lesion in liquid nitrogen for 20 min, and reconstruction using intramedullary nailing, plates, or composite arthroplasty.Postoperative function was excellent in 25 patients (75.7%), good in 5 patients (15.1%), and fair in 3 patients (9.0%). At the final follow-up, 8 patients had died at a mean of 17 months postoperatively, and 18 patients remained disease-free for a mean follow-up period of 30 months (range 7-69 months). Seven patients were alive but with disease. Complications were encountered in 12 patients, including 4 deep infections, 3 fractures, 3 local recurrences from surrounding soft tissue, 2 nonunions, and 1 collapse. All were managed successfully.The pedicle frozen autograft, which was newly developed to solve drawbacks of previously reported free frozen autografts, achieved success for reconstruction of malignant bone tumors. This is a new, simple, effective surgical technique for biological reconstruction that is still investigated but has potential for development.